POS1065 IMPACT OF HYPERURICEMIA ON CLINICAL PHENOTYPE, COMORBIDITIES, AND RESPONSE TO SECUKINUMAB IN PSORIATIC ARTHRITIS: POST HOC ANALYSIS OF FUTURE AND MAXIMISE STUDIES
Authors: R. Felten, L. Widawski, L. Spielmann, C. Gaillez, W. Bao, J. E. Gottenberg, P. M. Duret, L. Messer
Journal: Annals of the Rheumatic Diseases (2022)

Background Hyperuricemia (HU) is a metabolic abnormality associated with psoriasis (PsO) and psoriatic arthritis (PsA) 1 . The prevalence of HU is 2–13% in general population, 19–20% in PsO patients (pts), and 27–32% in PsA pts 1,2 . Pts with PsO/PsA are at significantly increased risk of HU and development of gout 1 . The pathogenic role of chronic HU in the development and maintenance of PsA is based on epidemiological, clinical, and fundamental arguments and hence does not appear fortuitous. These processes can influence each other 3 . Moreover, PsA with HU has been shown to be more peripheral, destructive, and challenging to treat 4 . Objectives To evaluate the impact of HU on PsA in terms of clinical presentation, severity, comorbidities, and response to secukinumab (SEC) over 1-year. Methods This post hoc analysis included pooled data from PsA pts enrolled in the FUTURE 2–5 and MAXIMISE phase 3 trials. Pts were stratified into 2 groups based on baseline (BL) serum uric acid (SUA) level (HU: ≥360 µmol/L; without HU: &lt;360 µmol/L and no history of gout and/or uric acid lowering therapies [ULT]). Demographic and disease characteristics, PsA and therapeutic history, and comorbidities data, were collected at BL. Evaluations included ACR20/50/70 responses, Psoriasis Area and Severity Index (PASI) 90 response, resolution of enthesitis and dactylitis, Health Assessment Questionnaire Disability Index (HAQ-DI), and mean change in SUA level, up to Week 52. All analyses were performed at a descriptive level and data presented as observed. Results Overall, 2504 PsA pts were included in the analysis, of which 822 (32.8%) had HU (62 [2.5%] with gout; 49 [2.0%] treated with ULT). At BL, pts with HU were mostly male (76.0% vs 34.2%) and had a higher body mass index (30.9 vs 28.3 kg/m 2 ) with more comorbidities, such as hypertension (43.8% vs 31.3%), compared to pts without HU. A higher proportion of pts with HU had dactylitis (34.5% vs 25.9%), and PsO (48.3% vs 36.3%) with a greater mean PASI score (13.6 vs 10.2), compared to pts without HU (Table 1). The proportion of pts achieving ACR50, resolution of enthesitis/dactylitis, and mean change in HAQ-DI score were comparable up to Week 52 irrespective of BL HU status. The PASI90 response rate was higher in pts without HU with SEC 150 mg (with and without load) and similar in SEC 300 mg group irrespective of BL HU status (Figure 1). Table 1. Demographics and baseline characteristics Parameters, mean ± SD unless specified With hyperuricemia (N=822 ) Without hyperuricemia (N=1682 ) Age (Years) 48.5 ± 12.41 48.3 ± 12.19 Gender (Male), n (%) 625 (76.0) 576 (34.2) Weight (kg) 92.71 ± 18.62 79.59 ± 17.55 BMI (kg/m 2 ) 30.90 ± 5.86 28.33 ± 5.91 History of hypertension, n (%) 360 (43.8) 526 (31.3) History of diabetes mellitus, n (%) 85 (10.3) 144 (8.6) TJC 20.6 ± 15.52 21.3 ± 16.25 SJC 10.9 ± 9.31 10.8 ± 9.13 Enthesitis, n (%) 412 (50.1) 852 (50.7) Dactylitis, n (%) 284 (34.5) 436 (25.9) Evidence of current psoriasis; n (%) 397 (48.3) 611 (36.3) Mean PASI score* 13.61 ± 11.03 10.16 ± 9.13 TNFi naїve, n (%) 477 (58.0) 938 (55.8) MTX use at randomization, n (%) 321 (39.1) 685 (40.7) Serum uric acid (µmol/L) 420.7 ± 57.11 274.9 ± 51.98 CRP (mg/L) 11.6 ± 18.66 10.7 ± 23.36 *not collected in MAXMISE BMI, body mass index; CRP, C-reactive protein; MTX, methotrexate; SJC, swollen joint count; TJC, tender joint count; TNFi, tumor necrosis factor inhibitor Conclusion In this pooled analysis of SEC PsA studies, pts with HU reported a higher prevalence of hypertension, with more clinical dactylitis, and more PsO, with higher PASI score compared to pts without HU. Efficacy across all musculoskeletal manifestations was similar with SEC 150 and 300 mg; while PASI90 response rate was slightly better in patients without HU with SEC 150 mg, and similar with SEC 300 mg irrespective of HU status, at 1-year. References [1]Tripolino C, et al. Front Med . 2021;8:737573 [2]AlJohani R, et al . J Rheumatol. 2018;45(2):213–7 [3]Felten R, et al. Clin Rheumatol . 2020;39:1405–13 [4]Widawski L, et al. Clin Rheumatol. 2022. https://doi.org/10.1007/s10067-022-06061-x Disclosure of Interests Renaud FELTEN Consultant of: Novartis (Advisory board), Laura Widawski: None declared, Lionel Spielmann: None declared, Corine Gaillez Shareholder of: Novartis, Employee of: Novartis, Weibin Bao Shareholder of: Novartis, Employee of: Novartis, Jacques-Eric Gottenberg Consultant of: Novartis (Advisory board), Pierre-Marie Duret: None declared, Laurent Messer: None declared